Conservative vs Surgical Treatment for Displaced, Distal Diaphyseal-Metaphyseal Fractures of 5th Metatarsal Bone: A Prospective, Randomized Controlled Study

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: A distal diaphyseal-metaphyseal fractures of 5th metatarsal bone, so called Dancer’s fractures is one of the most common forefoot fractures. Displaced Dancer’s fracture can be treated by both conservative and surgical treatments; however, the most appropriate treatment remains controversial and there is currently no prospective comparative study comparing outcomes and complications between the two methods. The purpose of the study was to compare union rate, union time, functional outcomes, and complications between conservative and surgical treatment for displaced Dancer’s fractures. Methods: Thirty-two consecutive patients with displaced Dancer's fracture between 2-5 mm were prospectively randomized to 2 parallel groups to undergo either conservative (n=16) or surgical (n=16) treatment between 2020 and 2022. The minimum follow-up period was 12 months. The conservative group was treated with short leg cast and non-weightbearing for 4 weeks following with progressive weightbearing in CAM walking boot, while the surgical group was treated with ORIF with midfoot locking plate and heel weightbearing for 2 weeks and then following with full weightbearing in a CAM walking boot. Radiographic union was evaluated by weightbearing CT scan starting at 8 weeks followed by 3-week interval until union was achieved. Primary outcome was union rate confirmed on postoperative computed tomography (CT) scan. Secondary outcomes were union time, visual analog scale (VAS), Short Form-36 (SF-36), Foot and Ankle Ability Measure (FAAM), and recovery times including time to return to ADL, work, and sports. Results: There were no significant differences in demographic characteristics between the two groups. The union rate was 93 and 100 percent in conservative and surgical groups respectively (p>0.05). An average union time was significantly shorter in surgical group (8.7 weeks (SD=1.9)) than conservative group (16.7 weeks (SD=4.5)) (p< 0.001). The surgical group demonstrated a significantly shorter time to return to daily activities (8.6 vs 17.7 wks), work (9.2 vs 19.4 wks), and sports (17.5 vs 26.6 wks) (p< 0.05, all). Both groups demonstrated significant improvements in pain and functional outcomes, but there were no significant differences between the two groups. Overall complications and painful malunion was significant higher in conservative group, but other complications were not significant differences. The details of outcomes were listed on Table 1. Conclusion: Both conservative and surgical treatment led to significant improvements in pain and function in patients with displaced Dancer’s fracture. Although short-term functional outcomes and complication rates were not significantly different between the two techniques, surgical treatment demonstrated significantly shorter union time, lesser residual pain, and fasten recovery times without increasing the overall complication rate.